The Study Of Anal Sphincter Electromyography And Autonomic Nerve Damage In Parkinson's Disease And Multiple System Atrophy

The study of anal sphincter electromyography and autonomic nerve damage in Parkinson's disease and multiple system atrophy Objective:1.Autonomic nervous function damage and different characteristics of Parkinson's disease and multiple system atrophy;2.Objective to evaluate the value of sphincter electromyography in the diagnosis of Parkinson's disease and multiple system atrophy.Methods:1.From September 2014 to February 2016 in the patient visits to the neurology department of XXX Hospital outpatient and inpatient were 110 cases,including 50 cases of Parkinson's disease(PD)patients,multiple system atrophy(MSA)in 60cases;Collected 20 cases of health examination in XXX Hospital medical.2.According to the international diagnostic criteria and clinical manifestations,all the subjects were divided into three groups by Parkinson disease(PD)group,multiple system atrophy(MSA)group and normal control group.According to the lenght of the Parkinson's disease,PD patients were divided into course of PD disease less than 5 years group and course of PD disease more than 5 years PD group.According to the different subtypes of patients with multiple system atrophy,they were divided into three groups: MSA-A group,MSA-C group and MSA-P group.3.Register the general information of all the subjects,including name,gender,age,marital status,occupation,weight,home address,contact information,etc..The history of each selected object was investigated in detail,including the onset time,initial symptoms,course of disease,the main clinical manifestations accompanied by autonomic dysfunction symptoms,medication,past history,personal history,etc..Physical examination of the nervous system including face,consciousness,mental state and other general examination,twelve pairs of cranial nerve examination,motor system examination,sensory system examination,pathological reflex examination.Analysis of the clinical features of head MRI,anal sphincter electromyography andautonomic nerve function damage.4.The parameters of ASEMG of anal sphincter electromyography were recorded,including mean time limit,average amplitude,percentage of multiphase wave and satellite potential.Results:1.A total of 50 patients were collected from the Parkinson study,including 26 males and 24 females,aged from 28 years old to 83 years old,with average age range62.80±9.97 years,course of disease from 0.02 year to 24 years,(mean duration 5±5.83years).All patients with multiple system atrophy were enrolled in this study,including 31 males and 29 females,aged from 34 years old to 82 years old,with average age range 57.12±82 years,course of disease from 0.2 year to 12 years,(mean duration 2.87±2.31 years).A total of 20 healthy persons were collected,including 11 males and 9 females,aged from 35 years old to 83 years old,with an average age of53.5 ±12.04 years.2.The first symptom of PD group was 34 cases of limb shaking(accounting for74%),motor retardation in all cases(accounting for 12%),general weakness in all cases(accounting for 8%),urinary tract obstruction in 4 cases(accounting for 8%)and cognitive impairment in 2 cases(accounting for 4%).The first symptom of MSA group had 19 cases of dizziness(accounting for 31.67%),language disorder in 2 cases(accounting for 3.33%),16(accounting for 26.67%)cases of bradykinesia,limb shaking in 18 cases(accounting for 30%),fatigue(accounting for 5%),3 cases of urinary dysfunction in 2 cases(accounting for 3.33%).3.PD and MSA were the main clinical manifestations varied,PD were mainly for Parkinson like symptoms including limb jitter,gait instability,slowness of movement in 36 cases(accounting for 72%),autonomic nervous function damage symptoms were 21 cases(accounting for 42%);MSA patients mainly manifested as Parkinson like symptoms including unstable gait,speech clearly,the slow movement in 37 cases(accounting for 61.67%),autonomic nervous function damage symptoms were 32 cases(accounting for 53.33%).4.From clinical manifestation: There were 21 cases of autonomic nerve dysfunction in PD patients,accounting for 42%,One of the most prominentsymptoms of digestive system symptoms constipation in 14 cases,accounting for66.67%,Followed by: frequent micturition,urgency in 10 cases,accounting for47.62%;nocturia in 9 cases,accounting for 42.86%;7 cases of abnormal sweating,accounted for 33.33%;orthostatic hypotension in 4 cases,accounting for 19.05%;2cases of sexual dysfunction,accounting for 9.52%.MSA patients have autonomic nervous function damage in 32 cases,accounting for 53.33%,which is the most prominent symptoms of urinary symptoms of urinary frequency and urgency in 23 cases,accounting for 71.86%;20 cases of urinary incontinence,accounting for62.50%;Followed by: orthostatic hypotension in 14 cases,accounting for 43.75%;11cases of abnormal sweating,accounted for 34.38%;9 cases of constipation,accounted for 28.13%;3 cases of sexual dysfunction,accounting for 9.38%.5.50 cases of PD patients with ASEMG findings in 9 cases(accounting for 18%)study showed neurogenic damage,11 cases(accounting for 22%)of the mean duration of MUP more than 10 ms,42 cases(84%)of percentage of polyphasicity >40%,8 cases(accounting for 16%)of satellite potential.60 cases of MSA patients with ASEMG findings in 53 cases(accounting for88.33%)study showed neurogenic damage,55 cases(accounting for 91.67%)of the mean duration of MUP more than 10 ms,52 cases(accounting for 86.67%)of percentage of polyphasicity >40%,38 cases(accounting for 63.33%)of a satellite potential.20 cases of PD patients with ASEMG findings in 1 cases(accounting for 5%)study showed neurogenic damage,2 cases(accounting for 10%)of the mean duration of MUP more than 10 ms,5 cases(accounting for 20%)of percentage of polyphasicity >40%,1 cases(accounting for 5%)appeared satellite potential.6.The PD group,MSA group and normal control group were divided into three groups according to >10ms(mild)(10.0ms-11.9ms),moderate(12ms-13.9)and severe(>14ms): PD group was prolonged in 7 cases(accounting for 14%),3 cases of moderate extension(accounting for 6%),1 cases of severe prolonged(accounting for2%),39 cases were normal(accounting for 78%).MSA group was prolonged in 19cases(accounting for 31.67%),32 cases of moderate extension(accounting for53.33%),4 cases of severe prolonged(accounting for 6.67%),normal in 5 cases(8.33%);2 cases of normal control group slightly increased(accounting for 10%),0cases of moderate and severe prolonged extension in 0 cases,18 cases were normal(accounting for 90%).7.The ASEMG results of the three groups were analyzed:PD patients showed motor unit action potentials(MUP)the average time slightly prolonged,rarely satellite potential;MSA patients showed motor unit action potentials(MUP)the average time was significantly prolonged,with more satellite potential,MSA autonomic nerve function in patients with the involvement of a wider range,the higher the rate of emergence of satellite potential.With MSA satellite potential rate and the mean duration of MUP was significantly higher than that of PD patients.Conclusions:1.In all the subjects,the condition of the male patients was more serious than that of the female patients.The symptoms of autonomic nerve function damage gradually increased with the increase of the age,the course of the disease and the severity of the disease.2.All the research objects,symptoms of autonomic dysfunction are common,the digestive system symptoms of constipation in patients with PD showed the most symptoms of autonomic dysfunction,urinary symptoms of urinary frequency and urgency is MSA in patients with autonomic dysfunction symptoms most.3.The results of ASEMG the MUP average time extension degree and satellite potential occurrence rate is very important for the identification of PD and MSA,with occurrence rate of satellite potential and motor unit action potentials(MUP)the average time limit for the main identification index.4.The abnormal degree of ASEMG findings in patients with MSA was correlated with the degree of autonomic nerve function damage.